Forum for Nordic Dermato-Venereology Nr1,2019 | Page 26
Case Report
Black Hairy Tongue (Lingua villosa nigra)
C arsten S auer M ikkelsen 1 , K arianne R ømer -M echlenborg 2 , P eter B jerring 3
and
L uit P enninga 4
Specialist in Dermatovenereology, and Sygeplejerske, Tolstrupvej 91, DK-9700 Broenderslev, Specialist in Dermatovenereol-
ogy. Professor, Molholm Private Hospital and Bispebjerg Hospital, Copenhapen, Denmark, and 4 Specialist in Surgery, Ilulissat
Hospital Avannaa Region, Ilulissat, Greenland. E-mail: [email protected]
1
2
C ase
A
36-year-old otherwise healthy man came to the clinic
complaining about bad breath, a tickling sensation on the
tongue and altered taste buds. He had an excessive intake of
alcohol (minimum 8 units daily), tobacco (40 cigarettes daily)
and coffee (12 cups daily).
He presented with a history of 6 weeks with black discoloration
of his tongue. He denied new medication or use of mouthwash
containing hydrogen peroxide. His tongue was tested negative
for pathogenic bacteria and fungal infections.
The patient had poor oral hygiene. He was diagnosed with
“black hairy tongue“ (BHT) and after minimizing his intake
of alcohol, tobacco and coffee and brushing his teeth and
tongue twice daily the condition resolved.
D iscussion
BHT occurs in about 0.5% of adults (1). However, the preva
lence is variable depending on the population studied (2).
The distinct dark, furry appearance usually results from a
build-up of dead skin cells on the many tiny papillae on the
surface of the tongue containing taste buds. These papillae,
which are longer than normal, can easily trap and be stained
by bacteria, yeast, tobacco, food or other substances (2). The
hairy tongue is often black, but can also appear brown, yellow,
green and a variety of other colours.
3
Predisposing factors include excessive intake of alcohol and
smoking, xerostomia (dry mouth), soft diet, poor oral hygiene
and certain medications (2). Medications commonly associated
with BHT are bismuth, antibiotics and medications that have
xerostomia as a side-effect, for example antipsychotics (3).
Management is by improving oral hygiene, especially scraping
or brushing the tongue (2). In addition, discontinuation of
alcohol, smoking and a soft diet is advised (3).
Global variation in the prevalence of black hairy tongue oc-
curs due to differences in diet, oral hygiene habits, and oral
flora (3). The condition is more common in males and in the
elderly. This may be associated with a higher smoking rate and
poorer oral hygiene in these groups. Although more common
in elderly the condition can occur in people of all ages, and the
condition has even been reported in a 2-month-old infant (4).
Differential diagnosis includes pseudo-BHT secondary to
chemicals or food colouring, pigmented fungiform papillae of
the tongue, hairy leukoplakia, Addison disease, Peutz-Jeghers
syndrome, Laugier-Hunziker syndrome, amalgam tattoo,
lichen planus pigmentosus and congenital naevi.
BHT represents a relatively uncommon condition, causing
great concerns in affected individuals, due to its clinical pres-
entation. BHT is a benign condition, but people who are affect-
ed may be distressed at the appearance and possible halitosis
and burning mouth, and therefore treatment is indicated (1).
The authors have no conflicts of interest to declare.
R eferences
1. Neville B, Damm DD, Allen C,Bouquot J, editors. Oral and Max-
illofacial Pathology (2. ed.). Philadelphia: W.B. Saunders. 2002;
Fig. 1. Black hairy tongue before and after treatment.
Photo: Carsten Sauer Mikkelsen
24
pp. 13–14.
2. Sarti GM, Haddy RI, Schaffer D, Kihm J. Black hairy tongue. Am
Fam Physician 1990; 41: 1751–1755.
3. Gurvits GE, Tan A. Black hairy tongue syndrome. World J Gastro-
enterol 2014; 20: 10845–10850.
4. Poulopoulos AK, Antoniades DZ, Epivatianos A, Grivea IN, Syro-
giannopoulos GA. Black hairy tongue in a 2 month-old infant. J
Paediatr Child Health 2008; 44: 377–379.
Forum for Nord Derm Ven 2019, Vol. 24, No. 1